Invoice Optometrist in Spain Valencia –Free Word Template Download with AI
Professional Optometry Services
Carrer de Colón, 45, 2º Izquierda
46004 Valencia, Spain
Tel: +34 960 123 456
Email: [email protected]
NIF: B-12345678
Collegiate Number: COOV-1234
Invoice Number: INV-2023-10-089
Date of Issue: October 24, 2023
Due Date: November 24, 2023
Service Date: October 20, 2023
Billed To
Mr. Alejandro Martinez Ruiz
Av. del Puerto, 12, 3ºD
46021 Valencia, Spain
NIF: 12345678Z
Patient Details
Name: Mr. Alejandro Martinez Ruiz
Date of Birth: 15/05/1985
Insurance: Sanitas (Policy #SAN-998877)
Referral: Self-Referral
| # | Description of Optometry Services | Qty | Unit Price (€) | Total (€) |
|---|---|---|---|---|
| 1 |
Comprehensive Adult Eye Examination Includes visual acuity testing, refraction, tonometry (eye pressure), and ocular health assessment. |
1 | 65.00 | 65.00 |
| 2 |
Dilated Fundus Examination Detailed examination of the retina, optic nerve, and macula using mydriatic drops to detect early signs of pathology. |
1 | 35.00 | 35.00 |
| 3 |
Binocular Vision Assessment Evaluation of eye teaming, focusing, and tracking abilities to rule out convergence insufficiency or amblyopia. |
1 | 25.00 | 25.00 |
| 4 |
Prescription Lenses (Progressive) High-index 1.67 progressive lenses with anti-reflective, anti-scratch, and blue light filtering coatings. |
1 | 180.00 | 180.00 |
| 5 |
Titanium Full-Rim Frame Lightweight, hypoallergenic titanium frame selected during consultation. |
1 | 120.00 | 120.00 |
| 6 |
Dispensing and Adjustment Fee Professional fitting, alignment, and patient education on lens care and adaptation. |
1 | 15.00 | 15.00 |
Terms, Conditions, and Clinical Notes
Payment Terms: Payment is due within 30 days of the invoice date. Late payments may incur a statutory interest charge as per Spanish Law 3/2004 on Late Payment in Commercial Transactions.
Bank Transfer Details: Please reference Invoice Number INV-2023-10-089 when making payments.
Bank: Banco Santander
IBAN: ES91 0049 0001 2345 6789 0123
SWIFT/BIC: BSCHESMM
Clinical Disclaimer: This invoice documents the professional optometry services rendered by a licensed Optometrist in Valencia, Spain. The examination results and prescription provided are valid for one year from the date of service. This document does not constitute a medical diagnosis of systemic disease, though ocular signs suggestive of such conditions were noted and referred to the patient's primary care physician.
Warranty: All optical products sold are covered against manufacturing defects for a period of 12 months from the date of purchase. This warranty does not cover damage resulting from misuse, accidents, or normal wear and tear.
Data Protection: In accordance with the General Data Protection Regulation (GDPR) and Spanish Organic Law 3/2018, your personal and health data will be processed solely for the purpose of providing optometric care and billing. You have the right to access, rectify, and delete your data by contacting our data protection officer.
Authorized by:
Dr. Elena GomezLead Optometrist
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